Teericka Kimbrough, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149026839 Issued in IL

Practice address

1761 N Dilleys Rd Ste 210
Gurnee, IL 60031-1721

Phone

(773) 683-7392

NPI assigned

Mar 22, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, IL

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1639929870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9130 83RD ST APT 133",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531582558",
            "telephone_number": "773-683-7392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 N DILLEYS RD STE 210",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311721",
            "telephone_number": "773-683-7392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9130 83rd St Apt 133",
            "address_purpose": "LOCATION",
            "city": "Pleasant Prairie",
            "state": "WI",
            "postal_code": "531582558",
            "country_code": "US",
            "telephone_number": "773-683-7392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBROUGH",
        "first_name": "TEERICKA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149026839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rakhi Khanna, D.O
• Rebecca Elizabeth Kholodovsky
• Tina Khoury, DMD
• Stephanie Kim, LSW
• Patricia K Kimbel, PSY.D.
• Kindred Life Ministries Inc
• Everett P Kirch, MD
• Rene Louise Kirklin
• Philip C. Kirschbaum, LCSW
• Lisa Klaber

• Clinical Social Worker in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.